JP4492881B2 - Ophthalmic surgery equipment - Google Patents

Description

  The present invention relates to an ophthalmic surgical apparatus for crushing and emulsifying a lens that has become clouded due to cataracts and the like, and removing it outside the body.

  An ophthalmic surgical apparatus that crushes and emulsifies a lens that has become cloudy due to cataracts, etc., and removes the lens from the body, amplifying and transmitting ultrasonic vibration to a tip attached to the tip of an ultrasonic crushing handpiece (hereinafter referred to as US handpiece). The nuclei are crushed and emulsified, and the crushed nuclei are sucked and removed through a tube from a suction hole provided in the chip together with the perfusate supplied into the eye.

  In this type of apparatus, it is necessary to appropriately adjust the perfusion fluid supply operation, the suction operation, and the ultrasonic vibration operation of the chip. For example, as shown in FIG. 13, these adjustments are performed by adjusting the foot switch. In the first step, the perfusion operation can be performed, in the second step, the perfusion + aspiration operation can be performed, and in the third step, the perfusion + aspiration + emulsification operation can be performed.

  By the way, in recent cataract surgery, the lens nucleus is divided into several parts by ultrasonic vibration or a surgical instrument, and each divided lens nucleus is sucked and held at the tip end of the US handpiece and moved to the center of the anterior chamber. The method of emulsifying and sucking after that has become the mainstream. In this method, by setting the suction pressure high, the split nucleus can be strongly sucked and held at the tip of the chip.

  In addition, a perfusion suction handpiece (hereinafter referred to as an I / A handpiece) is used in place of the US handpiece for suction removal of the residual cortex remaining after emulsifying and sucking all lens nuclei. The I / A handpiece performs the suction of the residual cortex using the same perfusion suction system as in the emulsification suction. The sucked residual cortex is discharged from the suction hole of the I / A chip attached to the tip of the I / A handpiece through the suction tube to the waste liquid bag. When removing a cortical piece tissue adhering to the capsular bag that cannot be removed by suction using an I / A handpiece, generally a lower suction pressure and a slower suction flow rate are used than when a residual cortex is suctioned. Then, the I / A chip is removed by rubbing the lens capsule weakly and polishing (hereinafter referred to as lens capsule polishing).

  However, depending on the hardness of the lens nucleus and the shape of the divided lens nucleus, the suction hole of the chip cannot be completely closed, and even if the suction pressure is set high during suction holding, the suction pressure remains at the set value. The lens nucleus may not be sufficiently retained without reaching.

  Also, when emulsifying and sucking nuclei by the action of ultrasonic vibration in the third stage, if the suction pressure is set too high, the suction flow rate may temporarily exceed the perfusion flow rate and the anterior chamber may be crushed. For this reason, the suction pressure cannot be set higher than necessary.

  Furthermore, in the lens capsule polishing using the I / A handpiece, there is a possibility that the posterior capsule may be damaged if the suction pressure remains high at the time of the residual cortical suction, so the suction pressure is set when shifting to the lens capsule polishing. It was necessary to rework, putting a burden on the surgeon.

  In view of the above problems, the present invention can sufficiently hold the divided lens nucleus at the tip of the tip, and can perform the lens capsule polishing appropriately without burdening the operator. It is a technical problem to provide a device.

  In order to solve the above problems, the present invention is characterized by having the following configuration.

(1) Perfusate supplying means for supplying perfusate into the eye, emulsifying means for crushing and emulsifying tissue in the eye using ultrasonic vibration, and waste in the eye together with the perfusate supplied into the eye In an ophthalmic surgical apparatus having a suction means for sucking and a foot switch that has a footrest portion and inputs a signal corresponding to the stepping amount of the footrest portion, the perfusion according to the signal of the foot switch depression position Setting means for setting the perfusion pressure of the liquid supply means, the suction flow rate or suction pressure of the suction means, and the emulsification power of the emulsification means at desired values, respectively, and the perfusion pressure, suction flow rate or suction for each position A setting means capable of registering a plurality of combinations of pressure and setting values relating to the emulsification power in advance, a selecting means for selecting one of the combinations registered by the setting means, and the selection The perfusion fluid supply means based on the perfusion pressure for each position in the combination selected by the means, the suction flow rate or suction pressure, the setting value of the emulsification power and the signal of the foot switch depression position, And a control means for controlling operations of the suction means and the emulsification means.

  As described above, according to the present invention, the lens nucleus after the division can be sufficiently held and the movement can be easily performed. In addition, the possibility of damage to the posterior capsule and the burden on the operator during polishing of the lens capsule can be reduced. Thereby, a surgery can be performed smoothly.

  Embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a schematic external view of a surgical apparatus according to the present embodiment, and FIG. 2 is a schematic configuration diagram.

  Reference numeral 1 denotes an apparatus main body. The main body 1 houses a control unit 5 that controls the entire apparatus. Reference numeral 2 denotes a US handpiece held by an operator. At the tip of the US handpiece 2, a tubular crushing tip 2a having a suction hole is attached. Ultrasonic vibration generated by the vibrator built in the US handpiece 2 is amplified and transmitted to the chip 2a, whereby the chip 2a crushes and emulsifies the lens nucleus. Driving energy is supplied to the vibrator of the US handpiece 2 via a cable connected to the main body 1. Reference numeral 3 denotes an input unit, which is a mode switch for changing the combination of perfusion, suction, and ultrasonic emulsification in response to the depression of the foot switch 6, and various settings such as perfusion pressure, suction flow rate, suction pressure, and ultrasonic output. A switch to perform is provided. The set value input by the input unit 3 is stored in the memory 7.

  Reference numeral 10 denotes a perfusion bottle containing a perfusion solution such as physiological saline for supplying to the patient's eye E, and reference numeral 11 denotes a perfusion tube for guiding the perfusion solution to the patient's eye E. The perfusion bottle 10 is suspended from a pole 12, and the pole 12 is moved up and down by a vertical drive device 13 (or manually) so that the height of the perfusion bottle 10 can be changed. The height of the perfusion bottle 10 is set so as to maintain the pressure in the patient's eye E appropriately. A control valve 14 is provided in the middle of the perfusion tube 11, and the outflow control of the perfusate is performed by opening and closing the control valve 14. One end of the perfusion tube 11 is connected to the perfusion bottle 10 side, and the other end is connected to the US handpiece 2 side for crushing. The US handpiece 2 is used by being connected to various handpieces depending on the surgical stage or method. For example, after all the lens nucleus is emulsified and sucked by the US handpiece 2, the I / A handpiece 8 is connected for suction removal of the remaining cortex remaining in the lens capsule and polishing of the lens capsule.

  Reference numeral 16 denotes a suction tube, which is used to discharge waste fluid such as perfusate sucked from the suction hole of the tip 2a attached to the US handpiece 2 and crushed and emulsified cores. In the middle of the rear of the suction tube 16, a peristaltic type suction pump unit 18 for generating suction pressure is disposed. The suction pump unit 18 is controlled by the control unit 5 and its suction flow rate is adjusted. The sucked waste liquid is discharged into the waste liquid bag 17.

  30 is a pressure sensor, 31 is a solenoid valve. The pressure sensor 30 and the electromagnetic valve 31 are connected to the suction tube 16 via the connection portion 32. The pressure sensor 30 always detects the suction pressure. When the suction hole at the tip of the tip 2a is blocked by a plug such as a crystalline lens nucleus and the suction pressure in the suction tube 16 reaches a set value, the control unit 5 controls the suction pump unit 18 based on the detection signal from the pressure sensor 30. After stopping, the pressure in the suction tube 16 is kept at a set value. Further, if necessary, the electromagnetic valve 31 is opened to lower the suction pressure.

  FIG. 3 is a view for explaining a stepping operation mechanism of the foot switch 6. Reference numeral 20 denotes a base portion, and 21 denotes a stepping portion. The rear portion (left direction in the figure) of the stepping portion 21 is connected to the base portion 20 by a shaft 22, and the stepping portion 21 can rotate about the shaft 22 in the direction of arrow A in the drawing. A spring 23 is interposed between the stepping portion 21 and the base portion 20, and when the force is not applied to the stepping portion 21, the state shown in FIG. 3 is maintained. Reference numeral 24 denotes a stepping amount transmission member having a gear portion 24 a. The stepping amount transmission member 24 is fixed in the stepping portion 21. Reference numeral 25 denotes a rotary potentiometer fixed to the base portion 20, and a gear 26 that meshes with the gear portion 24 a of the stepping amount transmission member 24 is attached to the rotation shaft of the potentiometer 25. When a force is applied to the stepping portion 21, the stepping amount transmission member 24 rotates about the shaft 22. This rotation is transmitted to the potentiometer 25 via the gear portion 24a and the gear 26, and the potentiometer 25 detects the amount of depression of the foot switch.

  Reference numeral 27 denotes a solenoid. The solenoid 27 is fixed to the shaft 22 by a mounting member 28 and rotates around the shaft 22 together with the stepping portion 21. Reference numeral 27a denotes a movable part of the solenoid 27. The movable part 27a is automatically returned by a spring (not shown) when no voltage is applied. A voltage is applied to the solenoid 27 when each step (see FIG. 5) of the stepping portion 21 is switched, and the solenoid 27 pulls and drives the movable portion 27a. Vibration is brought about by the pull-in drive of the movable part 27a, and the surgeon can recognize the change of each position.

  The foot switch 6 having such a mechanism can control the operations of perfusion, suction, and ultrasonic emulsification according to the depression position by the mode setting shown in FIG. In surgery using the US handpiece 2, a perfusion / aspiration / emulsification mode can be selected. In this mode, each operation of perfusion, suction, and ultrasonic emulsification is controlled as follows in response to the signal of the depression position of the foot switch 6 shown in FIG.

  When the depressed position of the foot switch 6 is at position 1, only the perfusate is supplied from the US handpiece 2. In position 2, in addition to the supply of the perfusate, the position 2-1 where suction is performed according to the suction pressure set by the input unit 3, and the same suction pressure as in the case of the position 2-1, is further weak to the chip 2a. A position 2-2 to which ultrasonic vibration is applied is provided. At position 3, the perfusion fluid is supplied, suction is performed according to the suction pressure set by the input unit 3 (a suction pressure different from that at position 2 can be set), and ultrasonic vibration for crushing emulsification is generated by the chip 2a. And can be ultrasonically emulsified. The output (emulsification power) of the ultrasonic vibration of the chip 2 a is changed by the amount of drive energy supplied to the vibrator built in the US handpiece 2. The drive energy amount is controlled by the control unit 5 based on the position signal of the foot switch 6 and the set value of the ultrasonic output by the input unit 3.

  The ultrasonic output control method at positions 2-2 and 3 is either a linear control that is controlled within the set range by depressing or depressing the foot switch 6, or a set constant regardless of the depressing or depressing of the foot switch 6. The panel control controlled by the ultrasonic output can be set in advance by the input unit 3.

  The operation of the ultrasonic surgical apparatus having the above configuration will be described below. Here, the operation in the technique of dividing the lens nucleus and emulsifying and sucking will be described.

  During the operation, the perfusion bottle 10 is installed, the tubes are attached to the US handpiece 2 and the suction pump unit 18, and other necessary preparations are performed. As the operation mode, the perfusion / aspiration / emulsification mode is selected by the mode selection switch of the input unit 3. In addition, the height of the perfusion bottle (in the apparatus of this embodiment, the perfusion pressure is set by the height of the perfusion bottle), the suction pressure, the suction flow rate, and the ultrasonic output (continuous oscillation and pulse oscillation can be selected). Setting is performed by a switch of the input unit 3. The height of the perfusion bottle is set to 70 cm, for example. In the suction control method, the suction flow rate is made constant, and the suction pressure is changed depending on the position of the foot switch 6. For example, at position 2, the suction pressure is set to a higher 250 mmHg so as to easily hold the divided lens nucleus at the tip 2a tip of the US handpiece 2. On the other hand, at position 3, if the suction pressure is set too high, the anterior chamber tends to collapse, so it is set to 160 mmHg, which is lower than at position 2. The ultrasonic output is set to 80% of the maximum output value at position 3 and 20% at position 2-2. In addition, the control method of the ultrasonic output is set to linear control in both positions 2-2 and 3 with continuous oscillation. FIG. 6 shows the relationship between the suction pressure and the ultrasonic output for each position of the foot switch 6 by these settings.

  Once the necessary settings have been made on the device side, an operation using the ultrasonic emulsification suction method is performed. The surgeon inserts the tip 2a of the US handpiece 2 into the eye through the incision while incising the sclera and anterior capsulotomy while observing the patient's eyes with a surgical microscope (not shown). The chip 2a is inserted while the foot switch 6 is depressed to the position 1 where only perfusion is performed, and the perfusion control valve 14 is opened to allow the perfusate to flow out. When the perfusate is supplied into the eyeball, the anterior chamber pressure of the eyeball is secured substantially constant due to the height position of the perfusion bottle 10.

  When the operator inserts the tip 2a into the sac, the operator depresses the foot switch 6 to position 3 to generate ultrasonic vibrations in the tip 2a in addition to supplying and sucking perfusate. The lens nucleus is divided into several small lens nuclei by the ultrasonic vibration of the chip 2a. Since the crystalline lens at this time is sufficiently fixed in the sac, it can be easily divided by the ultrasonic vibration of the chip 2a even with a relatively low suction pressure.

  When the lens nucleus is divided to some extent, each lens nucleus is emulsified and sucked. When emulsifying and sucking, the individual lens nuclei are adsorbed and held at the tip of the chip 2a, and moved to the central part incised by the anterior capsulotomy. In this operation, the vibration of the chip 2a is not necessary, and the divided lens nucleus is attracted to the tip of the chip 2a by a high suction pressure. At this time, the foot switch 6 is stepped on to the position 2-1 for perfusion and suction. Thus, the divided lens nucleus is sucked and held at the tip of the chip 2a.

  When sucking and holding the lens nucleus, if the suction hole at the tip of the chip 2a is not completely closed due to the hardness and shape of the lens nucleus, the foot switch 6 is depressed to the position 2-2. At position 2-2, the suction pressure is as high as at position 2-1, and ultrasonic vibration with a weak output is applied to the chip 2a. Therefore, the lens nucleus is gradually emulsified and crushed while being attracted, and the tip of the chip 2a gradually increases. It begins to bite into the lens nucleus. As a result, the suction hole at the tip of the chip 2a is closed, and the lens nucleus can be sufficiently held.

  When the lens nucleus is sufficiently held and moved to the center of the anterior chamber in this way, the foot switch 6 is depressed to position 3, and the moved lens nucleus is emulsified and removed by suction. Since the suction pressure at the position 3 is set lower than those at the positions 2-1 and 2-2, the anterior chamber is prevented from being crushed, and an operation with the anterior chamber stabilized can be performed.

  In the above-described embodiment, the position 2-2 is provided in the position 2 range where the suction pressure is set to be the same so that weak ultrasonic vibration can be applied. However, the suction pressure (or suction flow rate) can be changed. The position of the foot switch 6 may be divided into four stages. 7 to 10 are examples thereof. FIG. 7 shows an example in which the suction pressure at position 3 to which weak ultrasonic vibration is applied is set higher than positions 2 and 4. FIG. 8 is an example in which the ultrasonic output at position 3 is made constant and the suction pressure at position 2 is lower than that at position 4 in the example of FIG. FIG. 9 shows an example in which the ultrasonic output at position 3 is changed to pulse oscillation, and the suction pressure is changed linearly by stepping on the foot switch 6. FIG. 10 shows an example in which the suction flow rate is changed depending on the position of the foot switch. Further, as shown in FIG. 11, the position of the foot switch 6 is divided into other stages so that changes in suction pressure (or suction flow rate) and ultrasonic output (can be set to continuous oscillation or pulse oscillation) can be finely changed. May be.

  In this way, by increasing the position to change the suction and ultrasonic output according to the foot switch stepping operation, in each operation stage (grooving stage of lens nucleus, division stage, suction holding stage, emulsification suction stage, etc.) Accordingly, it is possible to easily switch between desired suction and ultrasonic output only by depressing the foot switch, and an appropriate operation can be performed. Also, whether to change linearly with each value of perfusion pressure, suction pressure, suction flow rate, and ultrasonic output is input and set for each position, so that multiple combinations can be registered and selected. In this case, it is convenient that a desired setting can be immediately selected according to the operation.

  Further, in the above-described embodiment, the ultrasonic vibration with weak output is generated only by the stepping mechanism of the foot switch 6, but the upper surface of the stepping portion is configured to be able to rotate in the lateral direction, and the upper surface of the stepping portion is positioned at the position 2. You may make it produce the ultrasonic vibration with a weak output in the chip | tip for crushing by rotating.

  The configuration of the foot switch in this case can be as shown in FIG. 12, for example. A foot plate 30 on which a surgeon places his / her foot is provided on the stepping portion 21. The foot plate 30 is pivotally supported by the shaft 31 so as to be rotatable with respect to the stepping portion 21, and the operator applies the side of the foot to the footrest portion 30 a while placing the foot on the foot plate 30. Can be swung to the right (in the direction of arrow C in the figure) from the surgeon indicated by. When the foot plate 30 is shaken (rotated), the potentiometer 41 detects the amount of vibration through the rotation transmission plate 40 and the gear 42 fixed to the lower surface of the foot plate 30. Reference numeral 32 denotes a return spring for returning the foot plate 30 to the initial position. With such a configuration, when the foot plate 30 is shaken at the stepping-in position 2 described above, emulsification with weak ultrasonic output can be performed.

  Furthermore, it is also possible to provide a separate switch and control the ultrasonic vibration with weak output by this switch.

  When the suction and removal of the lens nucleus by the US handpiece 2 is completed, the operator connects the US handpiece 2 to the I / A handpiece 8 and performs suction removal of the residual cortex and the like. The operator operates the switch of the input unit 3 to set the perfusion / aspiration mode, and sets the suction pressure and the suction flow rate optimal for the residual cortical suction and the lens capsule polishing to the respective foot switch positions. For example, as shown in FIG. 14, the suction pressure is set to about 10 mmHg (maximum value in a linear change) at position 2 so that a weak suction pressure suitable for lens capsule polishing is set at position 2, and about 500 mmHg at position 3 ( A suction pressure higher than the ultrasonic emulsification suction of the maximum value in the linear change is set to a suction pressure higher than the ultrasonic emulsification suction. As for the suction flow rate, a slow speed of about 10 cc / min is set at position 2, and an early speed of about 25 cc / min is set at position 3. Position 1 is such that only the perfusate is supplied. These settings may be set in advance before the operation and stored in the memory so that the settings are automatically changed when the mode is switched.

  The operator steps on the foot switch 6 to position 3 and sucks the residual cortex remaining in the lens capsule with a high suction pressure. When the residual cortex is removed by suction, the foot switch 6 is returned to position 2 or position 1 to polish the lens capsule. At this time, since the setting of the suction pressure and the suction flow rate at position 2 is sufficiently low, damage to the crystalline lens capsule can be suppressed. In addition, since the suction pressure and suction flow rate can be set according to the position position in advance and the suction pressure can be easily controlled with just a foot switch, the burden on the operator can be reduced and appropriate surgery can be performed with high efficiency. Can do.

  As described above, in the present embodiment, the position of the foot switch position 1 is set as the position for perfusion only, but a switch for turning on / off perfusion control is separately provided, and control by the foot switch position performs only suction and emulsification. It is also possible to do so.

It is the external appearance schematic of the perfusion suction apparatus which is an Example. It is a schematic block diagram of the perfusion suction apparatus which is an Example. It is a figure explaining the stepping-on operation mechanism of a foot switch. It is a figure explaining the operation | movement of the perfusion in each operation mode, suction, and ultrasonic emulsification. It is a figure which shows the operation | movement of the perfusion, the suction, and ultrasonic emulsification by the depression position position of the foot switch which is an Example. It is a figure which shows the example of a setting of the suction pressure with respect to each position of a foot switch, and an ultrasonic output. It is a figure which shows the example of a setting of the suction pressure with respect to each position of a foot switch, and an ultrasonic output. It is a figure which shows the example of a setting of the suction pressure with respect to each position of a foot switch, and an ultrasonic output. It is a figure which shows the example of a setting of the suction pressure with respect to each position of a foot switch, and an ultrasonic output. It is a figure which shows the example of a setting of the suction flow volume and ultrasonic output with respect to each position of a foot switch. It is a figure which shows the example of a setting of the suction parameter and ultrasonic output with respect to each position of a foot switch It is a figure explaining the example of a change of the mechanism of a foot switch. It is a figure which shows the operation | movement of the perfusion by the stepping position position of the conventional foot switch, suction, and ultrasonic emulsification. It is a figure which shows the example of a setting of the suction pressure with respect to each position of the foot switch at the time of perfusion / suction mode, and a suction flow rate.

Explanation of symbols

2 US handpiece 2a Tip 3 Input section 5 Control section 6 Foot switch 8 I / A handpiece 18 Suction pump section

Claims (1)

Perfusate supply means for supplying perfusate into the eye, emulsification means for crushing and emulsifying tissue in the eye using ultrasonic vibration, and suction for sucking waste in the eye together with the perfusate supplied into the eye In the ophthalmic surgical apparatus having a footrest portion and a foot switch that has a footrest portion and inputs a signal corresponding to the stepping amount of the footrest portion, the perfusate supply means corresponding to the signal of the footswitch depression position Setting means for setting the perfusion pressure, the suction flow rate or suction pressure of the suction means, and the emulsification power of the emulsification means at desired values, respectively, the perfusion pressure for each position, the suction flow rate or suction pressure, a pre-registered more possible settings means a combination of settings for emulsifying power, and selecting means for selecting one from among the combinations that are more registered by said setting means, to said selection means The perfusion pressure for each position in the selected combination I, the aspiration flow or suction pressure, the perfusate supply means based on the respective setting values and the position signal of the depression of the footswitch of the emulsifying power, An ophthalmic surgical apparatus comprising: a control unit that controls operations of the suction unit and the emulsification unit.